Impact on medication use and adherence of Australian pharmacists' diabetes care services.

OBJECTIVE: To assess the effect of a specialized service implemented in community pharmacies for patients with type 2 diabetes on medication use and medication-related problems. DESIGN: Parallel group, multisite, control versus intervention, repeated measures design, with three different regions in New South Wales, Australia, used as intervention regions, then matched with control regions as much as possible. INTERVENTION: After initial training, pharmacists followed a clinical protocol for more than 9 months, with patient contact approximately monthly. Each patient received an adherence assessment at the beginning and end of the study, adherence support, and a medication review as part of the intervention. MAIN OUTCOME MEASURES: Risk of nonadherence using Brief Medication Questionnaire (BMQ) scores and changes to medication regimen. RESULTS: Compared with 82 control patients, 106 intervention patients with similar demographic and clinical characteristics had significantly improved self-reported nonadherence as reflected in total BMQ scores after 9 months. The mean (+/-SD) number of medications prescribed at follow-up in intervention participants decreased significantly, from 8.2+/-3.0 to 7.7+/-2.7. No reduction was observed among the control patients (7.6+/-2.4 and 7.3+/-2.4). The overall prevalence of changes to the regimen was also significantly higher in the intervention group (51%) compared with controls (40%). CONCLUSION: Community pharmacists trained in medication review and using protocols in collaboration with providers improved adherence in patients with type 2 diabetes, reduced problems patients had in accessing their medications, and recommended medication regimen changes that improved outcomes.     

Exploring the implementation of a medication adherence programme by community pharmacists: a qualitative study

Background Medication adherence has been identified as an important factor for clinical success. Twenty-four Swiss community pharmacists participated in the implementation of an adherence support programme for patients with hypertension, diabetes mellitus and/or dyslipidemia. The programme combined tailored consultations with patients about medication taking (expected at an average of one intervention per month) and the delivery of each drug in an electronic monitoring system (MEMS6?). Objective To explore pharmacists’ perceptions and experiences with implementation of the medication adherence programme and to clarify why only seven patients were enrolled in total. Setting Community pharmacies in French-speaking Switzerland. Method Individual in-depth interviews were audio-recorded, with 20 of the pharmacists who participated in the adherence programme. These were transcribed verbatim, coded and thematically analysed. Process quality was ensured by using an audit trail detailing the development of codes and themes; furthermore, each step in the coding and analysis was verified by a second, experienced qualitative researcher. Main outcome measure Community pharmacists’ experiences and perceptions of the determining factors influencing the implementation of the adherence programme. Results Four major barriers were identified: (1) poor communication with patients resulting in insufficient promotion of the programme; (2) insufficient collaboration with physicians; (3) difficulty in integrating the programme into pharmacy organisation; and (4) insufficient pharmacist motivation. This was related to the remuneration perceived as insufficient and to the absence of clear strategic thinking about the pharmacist position in the health care system. One major facilitator of the programme’s implementation was pre-existing collaboration with physicians. Conclusion A wide range of barriers was identified. The implementation of medication adherence programmes in Swiss community pharmacies would benefit from an extended training aimed at developing communication and change management skills. Individualised onsite support addressing relevant barriers would also be necessary throughout the implementation process.     

Assessment of a medication management program targeting hypertension and diabetes patients: Impact on medication adherence

BackgroundThe National Health Insurance Service in South Korea has conducted a telephone outreach program to improve medication adherence for hypertension and diabetes patients since 2014.ObjectivesTo evaluate the direct outcomes of the program.MethodsPatients were identified among those who visited an outpatient clinic at least twice or used an inpatient service at least once for hypertension or diabetes during 6-month intervals and who were nonadherent based on the proportion of days covered (PDC) calculated. As a preliminary intervention, participants were mailed an information leaflet on their own medication adherence and other tips for effective self-management of chronic diseases. For the intervention, two phone calls and three phone messages were made to patients by 24 participating regional offices. Ultimately, 2,428 hypertension patients and 884 diabetes patients received the intervention. Propensity matching was used based on age, sex, and the Charlson Comorbidity Index to select 12,140 hypertension and 4,420 diabetes patients as controls in the non-participating regions. The outcome was PDC. Multivariate ordinary least squares or logistic regression analysis were used with difference-in-difference specification.ResultsThe adjusted quarterly PDC increased by 1.96%p for hypertension (p = 0.023) and by 7.79%p for diabetes patients (p < 0.001). Approximately 40.6% and 51.7% of hypertension and diabetes patients in the treatment arm (p = 0.0069) became adherent after the intervention, whereas the corresponding proportions were 37.7% and 41.4% (p < 0.001) in the control group. Both treatment groups showed a higher likelihood of good medication adherence (hypertension: odds ratio = 1.157, 95% CI [1.058, 1.265]; diabetes: odds ratio = 1.532, 95% CI [1.323, 1.774]). The control group, who received only a print intervention with a mailed leaflet, also showed a dramatic increase in medication adherence.ConclusionsAn insurer-coordinated telephone-administered program resulted in improvement of medication adherence among patients with hypertension and diabetes.     

Impact of an interactive workshop on community pharmacists' beliefs toward patient care

Background Patient assessment and documentation are less than optimal in pharmacy practice as preparing and dispensing medications is still a major part of community pharmacy practice. Pharmacists?? attitudes, specifically self-efficacy and role beliefs, toward practice have been shown to predict practice change. Objective This study will determine the impact of an interactive workshop on pharmacists?? attitudes toward assessment and documentation in routine pharmacy practice. Specific objectives included how (1) pharmacists?? role beliefs and self-efficacy toward assessment and documentation change after training and rehearsal and (2) frequently do pharmacists assess patient therapy and document patient care? Setting: ??Chat, Check and Chart: patient assessment and documentation demystified?? workshop Alberta College of Pharmacists Annual General Meeting in Calgary, Canada. Methods This study is pre?Cpost evaluation. Quantitative data on self-efficacy and role beliefs toward assessment and documentation was gathered from a validated written survey. Surveys were completed before and after the intervention. The intervention, an interactive workshop, focused on the use of three tools practice and was designed to support pharmacists in achieving the assessment and documentation required by the Alberta College of Pharmacists Standards for Practice. Main outcome measure: Pharmacists?? role beliefs and self-efficacy toward assessment and documentation in patient care. Results Of the 61 eligible pharmacists, the response rate was 61?% (37 pharmacists) with complete data. In the past 2 weeks, 54?% of pharmacists were assessing patients and 32.6?% of pharmacists were documenting greater than half the time. Prior to the workshop, pharmacists ??agreed?? (5.42?±?1.41) with their role in patient assessment and they were ??quite sure?? (4.75?±?1.10) they could assess patients. Pharmacists ??agreed?? (5.13?±?0.890) with their overall role in documentation of patient interactions and reported lower self-efficacy (3.88?±?1.32) for their ability to document patient interactions. After the interactive workshop, there were statistically significant increases in pharmacists?? self-efficacy and role beliefs in regards to both patient assessment and documentation (p?<?0.05). Conclusion This brief interactive workshop increased both self-efficacy and role beliefs towards assessment and documentation, indicating these pharmacists are likely to change future practice. Future research will assess practice uptake and implementation.     

Impact of pill burden on adherence to hepatitis C medication

Objective: To describe pill burden before and after hepatitis C virus (HCV) treatment initiation among patients newly treated for HCV infection, and to evaluate the association between HCV pill burden and gaps in HCV therapy.

Methods: This was a retrospective administrative claims study of patients treated with direct-acting antivirals (DAAs) for HCV from 1 November 2013 to 31 July 2016. HCV pill burden was defined as the pill count per day for the index HCV regimen. Mean overall pill burden (HCV medications plus non-HCV medications) was calculated in the 90?days before and after DAA initiation. Gaps in the index HCV regimen were assessed in the 6?months after DAA initiation. Multivariable logistic regression was used to compare the odds of a gap in HCV therapy across HCV pill burden categories (1 pill/day, 2 pills/day, and ≥3 pills/day).

Results: Among 9815 patients who met the study criteria, mean overall pill burdens before and after DAA treatment initiation were 5.4 and 7.7, respectively (p?<?.001). The adjusted odds ratio (OR) of a ≥15-day gap in HCV therapy was 1.75 (95% confidence interval [CI]?=?1.38–2.22) for patients with 2 HCV pills/day and 2.11 (95% CI?=?1.78–2.51) for patients with ≥3 pills/day, compared with patients with 1 HCV pill/day.

Conclusions: Patients with HCV have a substantial pill burden even before initiating HCV treatment. As higher HCV pill burden was associated with lower medication adherence, pill burden should be an important consideration in HCV treatment selection.     

高血压患者社区药物治疗的影响因素探讨

目的 探讨社区高血压患者坚持服药治疗的影响因素。方法 2001年9月至2005年4月，以新桂社区已确诊并建立档案的882名原发性高血压患者进行服药情况及相关因素调查和血压测量，对各相关因素进行服药依从性影响因素分析。结果 高血压患者服药依从率为21．43％。影响服药依从性的因素有性别、年龄、文化程度、家庭经济、亲友病史、高血压常识、血压升高程度、药物不良反应、药费贵。结论 高血压患者坚持服药的影响因素多样，提高服药率的关键是采用有针对性的个性化措施。     

Impact of an aminoglycoside kinetic service on aminoglycoside use in a community hospital.

The effectiveness of an aminoglycoside monitoring service in improving the prescribing patterns of physicians in the hospital was evaluated. A drug utilization review (DUR) done as part of routine monitoring demonstrated a deficiency in eight of 19 elements based on national DUR standards. An aminoglycoside monitoring program developed by the Pharmacy Department was then implemented. A comparative DUR demonstrated significant improvement in five previously deficient elements, a trend towards improvement in two elements, and no change in one element. We conclude that a concurrent drug monitoring program with aggressive pharmacy participation improves prescribing patterns by physicians.